Implementation of real-time probe-based confocal laser endomicroscopy (pCLE) for differentiation of colorectal polyps during routine colonoscopy

Tim D. G. Belderbos; Martijn G. H. van Oijen; Leon M. G. Moons; Peter D. Siersema

doi:10.1055/s-0043-117948

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(11): E1104-E1110
DOI: 10.1055/s-0043-117948

Original article

Implementation of real-time probe-based confocal laser endomicroscopy (pCLE) for differentiation of colorectal polyps during routine colonoscopy

Authors

Tim D. G. Belderbos

¹Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
Martijn G. H. van Oijen

²Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Leon M. G. Moons

¹Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
Peter D. Siersema

¹Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

³Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands

Abstract

Background and aims Probe-based confocal laser endomicroscopy (pCLE) is used to differentiate between neoplastic and non-neoplastic colorectal polyps during colonoscopy. We aimed to assess the accuracy of two endoscopists starting to use real-time pCLE for differentiation of colorectal polyps and to determine the negative predictive value (NPV) for neoplasia in polyps ≤ 5 mm.

Methods Patients undergoing colonoscopy in a tertiary hospital were included in this prospective trial. After a training session, two colonoscopists assessed 50 polyps between August 2012 and April 2014. They sequentially used narrow-band imaging (NBI) and real-time pCLE to differentiate non-adenomatous, adenomatous, and carcinomatous polyps during colonoscopy. Histologic diagnosis by a gastrointestinal pathologist was the gold standard. Results were compared to post-hoc pCLE by a panel of gastroenterologists and pathologists.

Results The accuracy of real-time pCLE was 76 %, compared to 73 % for NBI, and was not significantly different between the first 50 cases (74 %) and the last 50 cases (78 %, P = 0.64). The accuracy in polyps > 5 mm was 87 % versus 59 % in polyps ≤ 5 mm (P = 0.04) and increased from 45 % (13/29) in poor quality images to 86 % (44/51) in fair quality images and 95 % (19/20) in good quality images (P < 0.01). The post-hoc pCLE accuracy was 62 %. The NPV for polyps ≤ 5 mm was 58 % for real-time pCLE and 54 % for post-hoc pCLE.

Conclusion Although a fair accuracy of real-time pCLE for differentiation of colorectal polyps can be achieved within 50 cases, low NPV and difficulty in obtaining high-quality pCLE images hamper implementation in routine clinical practice.

Full Text

References

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